Issued by: Government Communications (GCIS)
HEALTH FOR ALL INT HE 21ST CENTURY : THE ROLE OF WHO
DR N ZUMA, MINISTER OF HEALTH OF SOUTH AFRICA
Meeting of Health Ministers of Countries of the Non-Aligned Movement Havana, Cuba 25 - 26 June 1998
Thank you Chairperson Dr. Dotres Your Excellencies Colleagues Ladies and Gentlemen
My country and my delegation are very grateful to the initiators and organizers of this meeting, President Castro and President Sampear, Minister Dotres and Minister Forero de Saade.
Its always a pleasure for me to visit this beautiful island and to enjoy the warm hospitality and generosity of the Cuban People. Our two peoples, though thousands of kilometres apart, feel very close because of the bonds that were cemented during the struggle and the cooperation that still continues, especially in the health sector. I will take this opportunity to thank the Cuban people for giving us more than four hundred of their finest men and women to assist us in our effort to provide health for all. Muchas gracias amigos.
Health for All
Our constitution defines health as a human right. That places an obligation on our government to do all in its power to achieve this goal. Health and Education are investments that have to be made for sustainable development and economic growth.
South Africa is a case in point where:
National action for Health for All and the role of WHO
The most important prerequisite for Health for All is the political will, without which this will never become a reality. Cuba, Mauritius and other countries demonstrate this clearly.
WHO's role should therefore, in the first instance, be one of advocacy. The organization should assist member states and ministries of health to entrench the political will to achieve Health for All.
The problems described above are common to most developing countries and I will briefly highlight the changes we have introduced, and where applicable, the assistance we have received or expect to receive from WHO.
1. Reorientation of the public health care system from a hospital based curative focus to a district based primary health care model. This has been done with the direct assistance from the relevant WHO program, but with equally valuable WHO support coming from the review of national programmes for tuberculosis, immunization and malaria.
2. Such reorientation has of necessity seen the diversion of resources away from academic hospitals. We have however attempted to retain health professionals in academic medicine through an improvement of their conditions of service, the promotion of national research efforts and the establishment of collaborative links with overseas institutions including the WHO.
3. A common challenge that faces us all, is to cultivate in aspirant health professionals an ethos of caring based on compassion and empathy. It is therefore with close interest that we follow the changes that are taking place in health education, and WHO is naturally an important player in this initiative.
4. Reforming the private sector and the establishment of a mutually beneficial private - public partnership are tasks that are currently underway. We recognize the importance of the private sector and realize that only by pooling scarce resources, can we hope to achieve the promise of Health for All. We will however draw on experiences of other countries and WHO to guide us on our way.
5. In order to reduce the costs of drugs for the South African public, legislation has been drawn up with the assistance of WHO, which provides for:
- an essential drugs list, - appropriate regulatory mechanisms, - the promotion of rational drug use, - the promotion of use of generics over branded products, - transparency in the pricing of drugs at each stage of the distribution process, - possible parallel importation of essential drugs, should the local supplier be unwilling or unable to deliver such products at the best available international price.
These measures are similar to measures adopted by national health departments in Western Europe where two thirds of drug purchases are from public funds.
WHO must be congratulated for the ongoing support it is providing to developing countries, in order to ensure access for their populations, to safe and affordable essential drugs.
With respect to monitoring the impact of these changes only 4 years later, we were expecting the epidemiological data to initially appear worse than predicted due to the improved methods in reporting and surveillance. It is therefore with considerable pride that I report that South Africa is recorded in the World Health Report of 1998, as one of only four countries in Africa to have met the health for all targets.
Regional role of WHO
The examples above have illustrated just a few ways in which WHO has made a contribution at the country level. However, since diseases do not recognize national boundaries, neighbouring countries often face common health problems that require coordinated action and where there are obvious benefits to be achieved through economies of scale. This model of developing a regional health agenda based on common national priorities represents sound logic. The emerging regional health structures are therefore regarded as important vehicles by which public health goals can be attained.
The formalization of the health sector of the Southern African Development Community (SADC), is one such structure and is currently headed by South Africa. WHO (AFRO) regional office has played a central role in providing support to many regional initiatives, for example the Southern African Tuberculosis Control Initiative (SATCI), and the regional malaria control program. We look forward to extending such collaboration with WHO. It size that any regional initiatives must originate from and be firmly anchoured to National programs.
Global role of WHO
At the global level we believe that WHO has several equally important roles to play.
1. WHO must be highly visible and stridently vocal in its defence of public health irrespective of the source of such perceived threats, be they from the neglect of national governments, the pursuit of political or commercial goals, or the prescription of economic quick fixes.
A recent editorial in the Health Horizon, the newsletter of the International Federation of Pharmaceutical Manufacturing Associations (IFPMA), advises the incoming director-General to concentrate more on action rather than on ideology.
We believe that Dr Brundtland will be called to defend public health on many occasions in the near future. However, armed with the principles and determination that we know she possesses, we rest assured that this defence is in the best possible hands.
2. WHO needs to articulate international health policy on evolving international issues that impact on the health sector but which may require a multi sectoral response or lead action by another sector eg:
- assisting countries to secure access to safe and affordable drugs.
- reviewing the impact of the indiscriminate application of market principles to the provision of health, in the light of a growing body of evidence that indicates that such actions extend rather than narrow the equity gap between rich and poor.
- mitigating the adverse effects of globalization on health.
- determining the role of the health sector in eradicating poverty,
- advising member states how best to protect public health, in the light of the forthcoming service sector negotiations at the world Trade Organization, which will include the liberalization of trade in health services.
- establishing the appropriate ethical guidelines with regard to genetic engineering and its related biotechnology. in particular, we should ensure that the public health benefits which accrue as a result of such technology, are accessible to those who have the greatest needs.
We find it interesting that while the International Convention on Biodiversity seeks to protect the planet's fauna and flora for the benefit of all mankind, patent offices in developed countries are inundated with applications which seek to patent everything from single cells, through to biological processes and complete microorganisms. Whole individuals appear to be excluded from this list only because slavery is still outlawed in most parts of the world.
Indeed, the planet's natural riches should be for the benefit of all mankind and not only those who hold the patents.
3. WHO must rebuild its technical base in order to re-establish itself as the premier organization concerned with world health. We see for example, an important role for the WHO as the collector and disseminator of information on International Best Practice and evidence based public health solutions.
WHO should make greater use of modern technology, such as Telemedicine, Telecare and Tele education, in order to extend services to the disadvantaged.
These traditional normative and standard setting roles must however be balanced with the advocacy and policy setting roles described above, for, if we believe in the holistic approach to health as a central component of primary health care, we cannot in all honesty, prescribe a passive bystander role for the originator of this philosophy.
In conclusion, no country should take pride in having achieved the Heal6th For All targets, whilst elsewhere on this planet, whole communities suffer under an intolerable burden of disease. Given the extent and speed of global travel today, infectious diseases can quickly appear at locations far removed from the traditionally endemic ares.
International solidarity in health is, therefore also a matter of self interest for some countries. WHO is the world's health conscience and must play a catalytic role in ensuring the achievement of Health For All.